Provider Demographics
NPI:1154447464
Name:PETER R PASHLEY D.O.,P.C
Entity Type:Organization
Organization Name:PETER R PASHLEY D.O.,P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:PASHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO,PC
Authorized Official - Phone:586-446-7870
Mailing Address - Street 1:38300 VAN DYKE AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-1123
Mailing Address - Country:US
Mailing Address - Phone:586-446-7870
Mailing Address - Fax:586-446-7871
Practice Address - Street 1:38300 VAN DYKE AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-1123
Practice Address - Country:US
Practice Address - Phone:586-446-7870
Practice Address - Fax:586-446-7871
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PETER R PASHLEY D.O.,P.C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-21
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013427207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1157410875OtherBCBS
MIH28848Medicare UPIN
MI0N95380Medicare PIN
MI0N95390Medicare PIN